Sinus Barotrauma: Prevention

Prevention of sinus barotrauma is achieved by refraining from diving with upper respiratory tract infections, sinusitis or rhinitis. Cessation of smoking will reduce the likelihood of mucosal irritation and sinus barotrauma. Avoidance of allergens may assist in persons so predisposed, as may treatment with local steroid nasal preparations. Correction of nasal abnormalities may be needed.

Systemic decongestants such as pseudoephedrine (Sudafed) are often used, as are topical nasal decongestants. Neither drug type is as effective as using the correct equalizing techniques. Positive pressure techniques during descent, such as the Valsalva manoeuvre, assist in aeration of the sinuses as well as the middle ears (as opposed to the passive equalization methods). Feet-first descents are preferable (i.e. head upright), and the techniques used for middle ear equalization (‘equalizing ahead of the dive’; see Chapter 7) are advised. Slow descents and ascents will reduce the sinus damage where there is only marginal patency of the sinus ostia.

Some physicians have found the use of proteolytic or allegedly mucus-softening enzymes to be of value. Well-controlled experimental trials are required to demonstrate any efficacy of these drugs.